REGISTRATION FORM - CLARKSBURG, WV CONFERENCE
Please print these 3 forms and fax or mail them to the information below. Not necessary if registering online. They must be postmarked and/or received on or before September 4th, 2013 (for the early savings date) OR postmarked and/or received on or before September 20th, 2013 (for the regular rate). Anything postmarked, faxed, mailed, received after September 20th, must pay the "at the door rate" (see above). Thank you.
To save on space, paper and to be able to read it more clearly, if you'd like, you may copy and paste all the information into a Word document, type in what's needed and then print that out to send in.
Phone #: ___________
E-mail (please print very clearly):
**This is very important. As the full registrations come in, I will be sending along several letters to keep you informed and for what to expect. Also, you may communicate with one another about room/ride sharing, etc. This has been a wonderful way to get to know one another and to help one another with expenses. Thank you for printing clearly!
If you need more room to write, please feel free to write elsewhere on this sheet.
Age (if under 18) ______________________________
Children under 12 are free. However EACH child under 12 must be accompanied by a fully registered, participating, responsible adult, who has authority to sign their waiver form. Due to the largely ministerial nature of the conference we ask that you consider the attention span of your child before registering them. There will be no sideline mothers for any youth. Thank you.
Enclosed please find (please check mark all that apply):
________ Registration $84 (On or Before September 4th)
________ Group rate $77**
________ Registration $99 (On or Before September 20th)
________ Group rate $92**
________ Registration $114 (On or Before October 4th)
________ Group rate $107**
________ Additional Love gift (helps offset conference expenses)
________ Donate a scholarship for someone else to go.
________ Total. Thank-you, and may the blessings of God over take you!!!
PAYMENT METHOD - Please Circle One
MC VISA AMEX DISCOVER CHECK MO (US FUNDS ONLY)
CC# _ _ _ _ - _ _ _ _ - _ _ _ _ - _ _ _ _
(CSC# for AMEX/DISC only)_____________
Please make checks or money orders payable and mail to:
Dancing For Him
5337 N. Socrum Loop, Suite 244
Lakeland, FL 33809 USA
Or fax forms (with credit card info) to: 863-583-7398
The amount of registrations, offerings, support, etc., is non-refundable. If for some unforeseen reason you will be unable to attend, your tax-deductible donation will be considered a love gift or scholarship to further the work of God through Dancing For Him Ministries. Thank-you for your generosity. NO one-day rates available. We encourage you to attend the entire conference or as much of the conference as you are able.
WAIVER OF LIABILITY (ADULT-18YRS. OR OLDER)
Please fill in, sign and mail in with your registration.
OR if registering here online, simply agree with your electronic signature in the box at the bottom of this page. When registering a group and putting a yes in the waiver drop down, that means that everyone in your group agrees.
In consideration of participation in this dance program and instruction, I the undersigned intending to be legally bound, here by for myself and anyone acting on my behalf, release any and all claims for damages I may have against Dancing For Him Ministries, Inc., Lynn Hayden and their sponsors, representatives, successors, and assigns for any and all injuries or death suffered by me in this program. I attest and verify that I know participation in this event can be a potentially hazardous activity. However, I have sufficiently prepared for this event and know that I am participating at my own risk. The waiver extends for the duration of the program. I also release DFH use of any video footage of me. I have read and understand this waiver of liability, and agree to the same.
YOUR SIGNATURE: _______________________DATE: ____________
Program: Worship Dance Workshop Date(s) of Program: October 4-5, 2013
WAIVER OF LIABILITY - CHILD (UNDER 18 YRS.)
PRINT CHILDS NAME:_____________________________________
OR if registering on line, simply put 'yes' in the child waiver agreement drop down list, at the bottom of this page, then put their name in the comments box after the credit card information, upon check out.
In consideration of participation in this dance program and instruction, I the undersigned intending to be legally bound, hereby for myself and anyone acting on my behalf, release any and all claims for damages I may have against Dancing For Him Ministries, Inc., Lynn Hayden and their sponsors, representatives, successors, and assigns for any and all injuries or death suffered by me in this program. I attest and verify that I know participating in this event can be a potentially hazardous activity. However, I have sufficiently prepared for this event and know that I am participating at my own risk. The waiver extends for the duration of the program. I also release DFH use of any video footage of me. I have read and understood this waiver of liability, and agree to the same.
SIGNATURE (Child): ________________________________ DATE: __________
Program: Worship Dance Workshop - Date(s) of Program: October 4-5, 2013
I am the parent and/or guardian of the aforementioned child. I consent to the waiver of liability on behalf of the child. I have read and understood this waiver of liability, and agree to the entire document intending to be legally bound thereby.
SIGNATURE (PARENT/GUARDIAN): ____________________________________
PRINT NAME (PARENT/GUARDIAN):_____________________
CONCERT REGISTRATION FORM - Clarksburg, WV
Are you and/or your group participating in the Saturday evening concert? YES/NO
If yes, please continue and fill out this form. Mail or fax it in with your registration/payment/waiver. Please remember it is first come, first served . Only the first 12 dances that are fully registered will be able to participate. Once it is full, a notice will be posted here, just under the CONCERT REGISTRATION FORM heading.
OR Just fill in the appropriate information in the comments box after entering your credit card information, upon check out.
Individual Name ____________________
Name of Team Presenting: _______________________
Number of people in dance: ___________________
Name of Song to which you'll be dancing:____________________
Name of Artist: ___________________________
Length of Song: _____________________(please, under 6 minutes)
Type of dance (worship, praise, hip/hop, mime, etc.): __________________